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Drug and alcohol addiction: new challenges

  • Jason Luty


There have been many developments in addiction psychiatry over the past decade. Some of these are political, such as preference for recovery-/ abstinence-based programmes. Prohibition is becoming increasingly unrealistic, especially considering the effective legalisation of recreational cannabis in Uruguay and two US states. Legal highs and diversion of prescribed drugs (such as methadone, gabapentinoids, methylphenidate and benzodiazepines) are now a major problem. Furthermore, diversion of opioid drugs that are prescribed for pain is reaching epidemic proportions, causing a significant change in the nature of patients being referred to addiction services.

Learning Objectives

  1. Be aware of political issues regarding abstinence-based treatment and prohibition.
  2. Be aware of risks and increased prevalence of diversion of drugs of misuse, especially opioid pain killers, gabapentinoids and benzodiazepines.
  3. Update knowledge of problems with methadone such as cardiac arrhythmias and diversion.


Corresponding author

Dr Jason Luty, Borders Addiction Service, The Range, Tweed Road, Galashiels TD1 3EB, Scotland. Email:


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American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA.
Amato, L, Minozzi, S, Davoli, M et al (2011) Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database of Systematic Reviews, 10: doi: 10.1002/14651858.CD004147.pub4.
Babor, TF, Caetano, R, Casswell, S (2003) Alcohol: No Ordinary Commodity. Oxford University Press.
Baldwin, DS, Aitchison, K, Bateson, A et al (2013) Benzodiazepines: risks and benefits. A Reconsideration. Journal of Psychopharmacology, 27: 967–71.
Birnbaum, HG, White, AG, Schiller, M et al (2011) Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Medication, 12: 657–67.
Boscarino, JA, Rukstalis, MR, Hoffman, SN et al (2011) Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the DSM-5 vs DSM-4 diagnostic criteria. Journal of Addictive Diseases, 30: 185–94.
British Medical Association, Royal Pharmaceutical Society (2014) British National Formulary (Aug issue). BMJ Group & Pharmaceutical Press.
Castro, VM, Clements, CC, Murphy, SN et al (2013) QT interval and antidepressant use: a cross sectional study of electronic health records. BMJ, 346: f288.
Department of Health (England) and the devolved administrations (2007) Drug Misuse and Dependence: UK Guidelines on Clinical Management. Department of Health (England), Scottish Government, Welsh Assembly Government and Northern Ireland Executive.
Drug Enforcement Administration (2011) Drugs of Abuse: 2011 Edition. A DEA Resource Guide. DEA.
Easton, M (2008) Drug treatment – success or failure? BBC blog: Mark Easton's UK. BBC ( Accessed Sep 2014.
Edwards, G, Gross, MM (1976) Alcohol dependence: provisional description of a clinical syndrome. BMJ, 1: 1058–61.
Faculty of Addictions Psychiatry (2014) One New Drug a Week: Why Novel Psychoactive Substances and Club Drugs Need aDifferent Response rrom Uk Treatment Providers (Faculty report FR/AP/02). Royal College of Psychiatrists (
Freynhagen, R, Geisslinger, G, Schug, SA (2013) Opioids for noncancer pain. BMJ, 346: 3841.
Gallup Organization (2011) Youth Attitudes on Drugs: Analytical Report (Flash Eurobarometer 330). European Commission.
Ghodse, H, Corkery, J, Schifano, F et al (2011) Drug-Related Deaths in the UK: Annual Report 2011. International Centre for Drug Policy, St George's, University of London.
Ghodse, H, Corkery, J, Claridge, H et al (2012) Drug-Related Deaths in the UK: Aunnaul Report 2012. International Centre for Drug Policy, St George's, University of London.
Gornall, J (2014) Under the influence: 2. How industry captured the science on minimum unit pricing. BMJ, 348: 1823.
Gossop, M, Marsden, J, Stewart, D et al (2001) Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug and Alcohol Dependence, 62: 255–64.
HM Government (2010) Drug Strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life. TSO (The Stationery Office).
Holland, R, Maskrey, V, Swift, L et al (2014) Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment: results from the Super C randomized controlled trial. Addiction, 109: 596607.
Hser, YI, Saxon, AJ, Huang, D et al (2013) Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction, 109: 7987.
Hubbard, RL, Craddock, SG, Anderson, J (2003) Overview of 5-year follow-up outcomes in the Drug Abuse Treatment Outcome Studies (DATOS). Journal of Substance Abuse Treatment, 25: 125–34.
Katz, NP, Birnbaum, HG, Castor, A (2010) Volume of prescription opioids used nonmedically in the United States. Journal of Pain and Palliative Care Pharmacotherapy, 24: 141–4.
Krantz, MJ, Martin, J, Stimmel, B et al (2009) QTc interval screening in methadone treatment. Annals of Internal Medicine, 150: 387–95.
Lim, SS, Vox, T, Flaxman, AD et al (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380: 2224–60.
Luty, J (2003) What works in drug addiction? Advances in Psychiatric Treatment, 9: 280–8.
Luty, J (2006) What works in alcohol use disorders? Advances in Psychiatric Treatment, 12: 1322.
Luty, J (2015) Addiction: new pharmacotherapies. Advances in Psychiatric Treatment, 21: in press.
Mokdad, AH, Marks, JS, Stroup, DF et al (2004) Actual causes of death in the United States, 2000. JAMA, 291: 1238–45.
National Institute for Health and Care Excellence (2014) Anxiety (Amended): Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care. NICE.
National Institute for Health and Clinical Excellence (2010) Appraisal Consultation Document: Zaleplon, Zolpidem and Zopiclone for the Management of Insomnia. NICE.
National Records of Scotland (2013) Drug-Related Deaths in Scotland: Statistics of Drug-Related Deaths in 2012 and Earlier Years, Broken down by Age, Sex, Selected Drugs Reported, Underlying Cause of Death and NHS Board and Council Areas. National Records of Scotland.
Noble, M, Treadwell, JR, Tregear, SJ et al (2010) Long-term opioid management for chronic noncancer pain. Cochrane Database of Systematic Reviews, 1: CD006605.
Nosyk, B, Sun, H, Evans, E et al (2012) Defining dosing pattern characteristics of successful tapers following methadone maintenance treatment: results from a population-based retrospective cohort study. Addiction, 107: 1621–9.
Nüesch, E, Rutjes, AW, Husni, E et al (2009) Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Database of Systematic Reviews, 4: CD003115.
Oude Voshaar, RC, Gorgels, WJMJ, Mol, AJJ et al (2003) Tapering off long-term benzodiazepine use with or without group cognitive–behavioural therapy: three-condition, randomised controlled trial. British Journal of Psychiatry, 182: 498504.
Pani, PP, Trogu, E, Maremmani, I et al (2013) QTc interval screening for cardiac risk in methadone treatment of opioid dependence. Cochrane Database of Systematic Reviews, 6: CD008939.
Parr, J, Kavanagh, DJ, Cahill, L et al (2008) Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction, 104: 1324.
Schifano, F, D'Offzi, S, Piccione, M et al (2011) Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data. Psychotherapy and Psychosomatics, 80: 118–22.
Sheron, N, Chilcoot, F, Matthews, L et al (2014) Impact of minimum price per unit of alcohol on patients with liver disease in the UK. Clinical Medicine, 14: 396403.
Stannard, C (2013) Opioids in the UK: what's the problem? BMJ, 347: f5108.
Starcevic, V (2012) Benzodiazepines for anxiety disorders: maximising the benefits and minimising the risks. Advances in Psychiatric Treatment, 18: 250–8.
Stitzer, ML, Bigelow, GE, Liebson, IA et al (1982) Contingent reinforcement for benzodiazepine-free urines: evaluation of a drug abuse treatment intervention. Journal of Applied Behavior Analysis, 15: 493503.
Stockwell, T, Auld, MC, Zhao, J et al (2012) Does minimum pricing reduce alcohol consumption? The experience of a Canadian province. Addiction, 107: 912–20.
Strain, EC, Bigelow, GE, Liebson, IA et al (1999) Moderate- vs high-dose methadone in the treatment of opioid dependence: a randomized trial. JAMA, 281: 1000–5.
Strang, J, Hall, W, Hickman, M et al (2010) Impact of supervision of methadone consumption on deaths related to methadone overdose (1993–2008): analyses using OD4 index in England and Scotland. BMJ, 341: c4851.
Substance Abuse and Mental Health Services Administration (2011) Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. US Department of Health and Human Services.
Vorma, H, Naukarinen, H, Sarna, S (2003) Long-term outcome after benzodiazepine withdrawal treatment. Drug and Alcohol Dependence, 70: 309–14.
Webster, LR, Webster, RM (2005) Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Medicine, 6: 432–42.
Weiss, RD, Potter, JS, Fiellin, DA et al (2011) Adjunctive counseling during brief and extended buprenorphine–naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Archives of General Psychiatry, 68: 1238–46.
Winstock, AR, Ramsey, JD (2010) Legal highs and the challenges for policy makers. Addiction, 105: 1685–7.
Zvosec, DL, Smith, SW, Porrata, T et al (2011) Case series of 226 gamma-hydroxybutyrate-associated deaths: lethal toxicity and trauma. American Journal of Emergency Medicine, 29: 319–32.


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Drug and alcohol addiction: new challenges

  • Jason Luty
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